Department of General Surgery University, Orjhans Street, Resalat Blvd, Urmia, 571478334 Iran.
Department of Radiology, Keck School of Medicine, University of Southern California (USC), 1500 San Pablo Street, Los Angeles, California 90033, USA.
Curr Med Imaging. 2022;18(3):275-284. doi: 10.2174/1573405617666210628154218.
Background: Small Bowel Obstruction (SBO) accounts for 15% of abdominal pain complaints referred to emergency departments and imposes significant financial burdens on the healthcare system. The most common symptom and sign of SBO is the absence of stool or flatus passsage and abdominal distension, respectively. Patients who do not demonstrate severe clinical or imaging findings are typically treated with conservative approaches. Patients with clinical signs of sepsis or physical findings of peritonitis are often instantly transferred to the operating room without supplementary imaging assessment. However, in cases where symptoms are non-specific or physical examination is challenging, such as in cases with loss of consciousness, the diagnosis can be complicated. This paper discusses the key findings identifiable on Computed Tomography (CT) which are vital for the emergent triage, proper treatment and appropriate decision making in patients with suspected SBO.
Narrative review of the literature.
CT plays a key role in emergent triage, proper treatment and decision making and provides high sensitivity, specificity, and accuracy in the detection of early-stage obstruction and acute intestinal vascular compromise. CT can also differentiate between various etiologies of SBO entity which is considered an important criterion in the triage of patients into surgical vs. non-surgical treatment.
There Key CT findings which may suggest a need for surgical treatment include mesenteric edema, lack of the small-bowel feces, bowel wall thickening, fat stranding in the mesentery, and intraperitoneal fluid which are predictive of urgent surgical exploration.
背景：小肠梗阻 (SBO) 占腹部疼痛就诊于急诊科的 15%，给医疗系统带来了巨大的经济负担。SBO 最常见的症状和体征分别是无粪便或气体通过以及腹部膨胀。没有表现出严重临床或影像学表现的患者通常采用保守治疗方法。有败血症临床征象或腹膜炎体格检查发现的患者通常立即转至手术室，无需补充影像学评估。然而，在症状不典型或体格检查困难的情况下，例如在意识丧失的情况下，诊断可能会变得复杂。本文讨论了在疑似 SBO 患者中，对紧急分诊、适当治疗和正确决策至关重要的 CT 上可识别的关键发现。
文献综述。
CT 在紧急分诊、适当治疗和决策中发挥着关键作用，在检测早期梗阻和急性肠血管损伤方面具有高灵敏度、特异性和准确性。CT 还可以区分 SBO 实体的各种病因，这是对患者进行手术与非手术治疗进行分诊的重要标准。
可能提示需要手术治疗的关键 CT 发现包括肠系膜水肿、小肠内无粪便、肠壁增厚、肠系膜脂肪条纹和腹腔内积液，这些发现提示需要紧急手术探查。
